Provider Demographics
NPI:1922067305
Name:UNIVERSITY NORTH DAKOTA
Entity Type:Organization
Organization Name:UNIVERSITY NORTH DAKOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-777-4845
Mailing Address - Street 1:MCCANNEL HALL ROOM 100
Mailing Address - Street 2:2891 2ND AVENUE NORTH STOP 9038
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58202-9038
Mailing Address - Country:US
Mailing Address - Phone:701-777-4500
Mailing Address - Fax:701-777-4835
Practice Address - Street 1:MCCANNEL HALL ROOM 100
Practice Address - Street 2:2891 2ND AVENUE NORTH STOP 9038
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9038
Practice Address - Country:US
Practice Address - Phone:701-777-4500
Practice Address - Fax:701-777-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922067305OtherCLINIC